Electrocorticographic-histopathologic correlations implying epileptogenicity of dysembryoplastic neuroepithelial tumor (DNT)

胚芽異形成性神経上皮腫瘍におけるてんかん原性領域を意味する頭蓋内脳波所見と組織所見の相関性

香川 幸太

Based on intracranial-video electroencephalography (EEG), histopathological features, and postoperative seizure outcome, we elucidated the epileptogenicity in patients with dysembryoplastic neuroepithelial tumor (DNT). Five patients (P1-P5) pathologically diagnosed with DNT underwent intracranial-video EEG to identify the ictal onset zone and irritative zone. We evaluated the correlations of ictal onset zone and irritative zone with the magnetic resonance imaging-visible lesion (MRI-lesion) and their histopathological features. Intracranial-video EEG located the ictal onset zone adjacent to the MRI-lesion margin in four patients with complex/simple forms of DNT subcategory, and on the MRI-lesion in P3 with a nonspecific DNT form. The irritative zone extended to surrounding regions of the ictal onset zone in all patients. Histopathologically, MRI-lesions were characterized by specific glioneuronal elements, whereas the ictal onset zone and irritative zone were represented with dysplastic cortex accompanying oligodendroglialike cells in four (P1, P2, P4, and P5) of five patients. Cortical dysplasia was identified with typical histopathologic features in the irritative zone remote from the MRI-lesion in P5. P3, with a nonspecific form, indicated prominent component of dysplastic cortex with oligodendroglia-like cells scattered in the MRIlesion. Lesionectomy of MRI-lesion with additional cortical resections (including the ictal onset zone and irritative zone) yielded postoperative seizure freedom (Engel Class I) in P3, P4, and P5, while P1 and P2 (with only lesionectomy) experienced postoperative residual seizure (Class II and III in each patient). Our results suggest the intrinsic epileptogenicity of DNT. The topographical correlation indicated that the dysplastic cortex accompanying oligodendroglia-like cells was more epileptogenic than the specific glioneuronal elements itself. Meticulous intracranial-video EEG analysis delineating the MRI nonvisible ictal onset zone and the irritative zone may yield better seizure outcome.

dysembryoplastic neuroepithelial tumor (DNT)

epileptogenicity

epilepsy surgery

intracranial electroencephalography (EEG)

histopathology

医学 [ 490 ]

英語

Copyright(c) by Author

[作成日] 2014-11-21

Kota Kagawa, Koji Iida, Akiyoshi Kakita, Masaya Katagiri, Takeshi Nishimoto, Akira Hashizume, Yoshihiro Kiura, Ryosuke Hanaya, Kazuhiko Sugiyama, Koji Arihiro, Kazunori Arita and Kaoru Kurisu; Electrocorticographic-Histopathologic Correlations Implying Epileptogenicity of Dysembryoplastic Neuroepithelial Tumor; Neurologia medico-chirurgica, Vol. 53 (2013) No. 10 p. 676-687 (doi: 10.2176/nmc.oa2012-0420) ～を参照している

[DOI] http://dx.doi.org/10.2176/nmc.oa2012-0420 ～を参照している

広島大学